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Indiana Application for Worker's Compensation Clearance Certificate (Spanish) - SF55718

State:
Indiana
Control #:
IN-55718-WC(S)
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Description

Application for Worker's Compensation Clearance Certificate (Spanish) - SF55718

Indiana Application for Worker's Compensation Clearance Certificate (Spanish) — SF55718 is a legal document used by employers in the state of Indiana to request that the Indiana Worker's Compensation Board issue a clearance certificate. This document is used to prove that an employer has fulfilled all of their obligations under the Indiana Worker's Compensation Act. The certificate verifies that the employer has paid all the required employee premiums and does not owe any outstanding balances. There are two types of Indiana Application for Worker's Compensation Clearance Certificate (Spanish) — SF55718: one for employers and one for employees. The employer's form must be filled out and signed by the employer, and the employee's version must be filled out and signed by the employee. Both forms must be submitted to the Indiana Worker's Compensation Board in order to receive the clearance certificate.

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FAQ

A: The law requires most businesses to have worker's compensation insurance. If you are injured while working at your job, you may be entitled to workers' compensation benefits. Q: When should I report an accident that happened on the job?

To receive this certificate clearance, you must meet the following requirements: All returns must be filed up to date. All outstanding delinquencies must be paid in full. All payments must be made in guaranteed funds. Form WCE-1 must be filed along with $20 non-refundable application fee in guaranteed funds.

In Indiana employers are required to purchase workers' compensation coverage if they employ one or more workers. Sole Proprietors, Partners and LLC Members are all excluded from coverage, but have the option to be included. Corporate Officers are included in coverage, but may elect to included.

Fine up to $10,000. Compensation not to exceed double the compensation provided by this Act; Medical expenses, and. Reasonable attorney fees.

How to File a Workers' Compensation Claim in Indiana Step-by-step process for filing a workers' comp claim. Step #1: Seek medical attention. Step #2: Notify your employer. Step #3: Make certain your employer files the necessary form. Step #4: Wait to receive a decision from the insurance company.

Indiana law requires that a sole proprietor or partner: who is an independent contractor in the construction trades, or is any other independent contractor, and. who does not elect to include himself as an employee, must file the WORKER'S COMPENSATION CLEARANCE CERTIFICATE APPLICATION with the Indiana Dept.

Exemptions Under Indiana Workers' Compensation Laws Sole proprietors, partners and LLC members. Corporate officers. Independent contractors. Licensed real estate agents.

Form 29109: Application for Adjustment of Claim The form may be filed by an injured worker who believes that he is entitled to compensation or medical benefits. An employer who believes that compensation should be terminated may also file the form. This form is also used to attempt to re-open a settled claim.

More info

Division of Workers Compensation main forms page. If the form is a fillable PDF, learn how to enable all fillable form features.To file a claim, complete the "Employee" section of the form, keep one copy and give the rest to your employer. Division of Workers' Compensation - Injured worker information.

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Indiana Application for Worker's Compensation Clearance Certificate (Spanish) - SF55718